Carotid
CAS

TIA in bilateral severe carotid disease

An 84-year-old man with a complex cardiovascular history, including prior TAVI and chronic kidney disease, presented with sudden-onset dysarthria. 

Imaging revealed an occluded left internal carotid artery and a subocclusive stenosis of the right internal carotid artery.

How should this critical bilateral carotid situation be managed?

Paolo Sbarzaglia
Paolo Sbarzaglia
Cotignola, Italy
Part I - Case presentation

Our patient is an 84-year-old man.

Cardiovascular Risk Factors

  • HTN
  • Former smoker

Medical history

  • 2007 → partial gastrectomy for gastric cancer, without chemotherapy or radiotherapy
  • 2024 → chronic myeloproliferative syndrome under clinical follow-up
  • Chronic kidney disease → stage 3b (GFR 40 ml)

Cardiovascular history

  • 2019 → TAVI for severe aortic valve stenosis
  • May 2025 → sudden onset of dysarthria → neurological diagnosis of TIA → supra-aortic trunks duplex ultrasound: sub-occlusion of RICA (PSV 4.8 m/sec) associated with suspected complete occlusion of LICA

Supra-aortic trunks angiography

Occlusion of the left internal carotid artery
Subocclusive stenosis of the right internal carotid artery

What will happen next?

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